student allowance independent circumstances allowance application form · 2019-12-12 · remember...

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is pageComplete this form if you are applying for Independent Circumstances as part of your Student Allowance and you are under 24 years old without children, and are separated and independent from both of your parents. You will also need to complete a Student Allowance application. The best way to do this is online at www.studylink.govt.nz

Find the best way to finance your future www.studylink.govt.nz

Student Allowance Independent Circumstances Allowanceapplication form

A parent includes a natural or adoptive parent, step-parent1 , partner2 of a parent, some caregivers, and any other person acting in place of a parent3 who is financially responsible for the student.

A person (including their spouse or partner) who is, or has been, a caregiver of a student is not considered a parent if they:

• are receiving or have received a Foster Care Allowance, Orphan’s Benefit or Unsupported Child’s Benefit for the student, or

• are providing or have provided a Transition Support Living Arrangement through Oranga Tamariki for the student.

If neither of your parents support you, you need to have one of the following exceptional circumstances to be eligible for the Independent Circumstances Allowance:

• You can’t live with or be supported by your parents because of a family breakdown.

• You are (or have been) living with a caregiver or an appointed legal guardian.4

• You are an orphan, and you haven’t lived with someone acting as a parent.

• One of your parents is in prison or a psychiatric hospital and the other parent can’t be responsible for you.

• You have other exceptional circumstances5 that mean it would be unreasonable for you to live with and receive financial assistance from any parent.1

We may need to speak to someone who can confirm your situation. If you’ve already spoken to a professional (such as a doctor, counsellor, lawyer or someone else of standing in the community) who is familiar with your situation, you can ask them to complete the supporting statement included with this application. Otherwise we may:

• need to speak to your parent(s)1 or someone else who can confirm your situation, or

• ask you to meet with someone to discuss your application.

1 A step parent is a person who is married, or in a civil union or de facto relationship with, the parent of the student.

2 A partner is a person who is married, or in a civil union or de facto relationship with, the parent of the student.

3 A person acting in place of a parent can include grandparents, other relatives (including whangai), and some current and former caregivers and guardians of the student.

4 People who have been appointed as a guardian by the Family Court .

5 Exceptional circumstances means circumstances that are highly unusual, or far beyond what is ordinary. The circumstances would need to be beyond your control. Choosing to live or study in a different city/town from your parents is not considered exceptional circumstances.

You must give us all the information we need.

If you do not have all the information we need, talk with us and we may be able to help.

If we find out later that any information you give us is not true, or that you knew information you should have told us and did not tell us, we may stop your payments. You might need to pay money back, we may impose a penalty, and you could be prosecuted.

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Before you start – Read this page

Here are some important things you need to know before you complete your application.Use blue or black ink only When completing your application you must only use blue or black ink. If your application has been completed in any other colour we might get you to complete another one.

Answer all the questionsIt’s important to answer every question in your application. If a question doesn’t apply to you, use ‘N/A’ or ‘nil’. Don’t leave the space blank, unless indicated on the form, as this could delay the process and you may not get paid on time.

You may need to provide documents When you apply for Student Allowance, you may need to provide certain documents as part of your application– these are listed on page 6.

All documents sent to StudyLink must be a verified copy. A verified copy is a copy of the original document which has been signed and dated by someone like a Solicitor/Lawyer, Notary Public, Court Registrar, an approved person at an education provider, school principal, StudyLink or Work and Income staff member or Justice of the Peace (listed in the Yellow Pages) who can confirm that the copy is the same as the original. They must print their name and title on each page and write that it is a true copy and sign it.

The best way to send your documents to us is online using www.connect.co.nz. Please remember to include your name and client number with any documents you send to us. For more information visit www.connect.co.nz

Remember to sign and date this application on pages 6 and 7 – and make sure anyone else who needs to sign it has done so.

How to return this form The easiest and fastest way to return your completed form to us is online using www.connect.co.nz Please remember to include your name and client number.

For more ways to contact us, visit our website www.studylink.govt.nz

IMPORTANT: Remember you also need to apply for a Student Allowance at www.studylink.govt.nz We need to receive your Student Allowance application by the end of the first week of your course (or the date you qualify if that’s later) or you may miss out on some payments. If you apply late it is unlikely your payments will be backdated.

http://www.connect.co.nz

www.studylink.govt.nz

Independent Circumstances Allowance application form Page 1

1. What is your client number?If you have received assistance from StudyLink or Work and Income before, write your client number here if you know it. This number can be found on your Community Services Card if you have one.

Client number

2. What is your full name?

First name Middle name(s) Surname or family name

3. What is your legal name as it appears on your birth certificate? (If different from above)


4. What date were you born?

Day Month Year

5. Where will you live while studying?If you live overseas, please provide a contact address in New Zealand.

Flat/House number Street address

Suburb City Post code Country

NEW ZEALAND

5a. What is your postal address?If you are not currently living at the above address, please give us your postal address.

If you live overseas, please provide a contact address in New Zealand. Please do not give the address of your education provider.



NEW ZEALAND

You can view your Student Allowance and Student Loan mail online at MyStudyLink and we’ll send you an email or text when you have new mail to view.

5b. How can we contact you?We will contact you between 8am and 4pm, Monday to Friday to discuss your situation.

Phone Mobile1 Fax Email1

1 If you give us your mobile number or email address we may use these to send you text messages or emails to let you know about important changes, appointment reminders or that it’s time to reapply if you’re continuing with your studies. This must be your own mobile number or email address. Do not give the contact details of your education provider.

Independent Circumstances Allowance application form

6. Will you be living with your parent(s) or any person acting as a parent while studying?

Yes No

If yes, it is unlikely your application will be approved – call us on 0800 88 99 00 to discuss this.

6a. Are your parent(s) financially supporting you in any way?

Yes No

If yes, it is unlikely your application will be approved – call us on 0800 88 99 00 to discuss this.

7. Have you had a Youth Payment or Young Parent Payment in the last year?

Yes (Go to Q9) No

8. Have you had an Independent Circumstances Allowance in the last year?

Yes No (Go to Q9)

8a. If yes, have your circumstances changed in any way?For example, you have moved back home, or you have started living with someone who’s acting as a parent to you.

Yes No (Go to ‘Student’s declaration’ on page 6)

8b. If yes, please tell us what’s changed:

9. Why are you applying for the Independent Circumstances Allowance?My parent(s) and I had a breakdown in our relationship, now I can’t live at home and my parent(s) do not financially support me (Go to Q9a).

I am (or have been) living with a caregiver or appointed legal guardian (Go to Q10).

I am an orphan and haven’t lived with anyone acting as a parent (Go to Q11).

One of my parents is in prison or a psychiatric hospital and my other parent also can’t be responsible for me (Go to Q9a).

I have other exceptional circumstances that mean it would be unreasonable for me to live with and receive financial assistance from any parent (Go to Q9a).

We may need to see some evidence of your situation – see the checklist on page 6.

9a. Please explain your circumstances. For example, who you have had a breakdown with and why. You can continue on a separate page if required.

1 People who have been appointed as a guardian by the Family Court .


9b. When did you stop living with your parent(s)?

Day Month Year

9c. When did your parent(s) stop supporting you?

Day Month Year

10. How can we contact your parent(s), caregivers or appointed legal guardian? We need to talk to them to confirm the information you give us.

Parent, caregiver or appointed legal guardian One

First name Middle name(s) Surname or family name Relationship to you



Phone Mobile Fax Email

Parent, caregiver or appointed legal guardian Two

First name Middle name(s) Surname or family name Relationship to you




10a. Who else can we contact to discuss your situation? This could be your doctor, counsellor or someone else of standing in the community such as your School Principal, Minister or Kaumātua. It should be someone you’ve already spoken to about your situation, or someone who knows about your situation and has known you for at least a year.

First name Surname or family name

Relationship to you





11. Please tell us more about your situation. This is important for us to assess your application.For example, how you have been supporting yourself. You can continue on a separate page if required.


Privacy statementThe Ministry of Social Development includes Work and Income, MSD Housing Assessment, Senior Services, StudyLink and other service lines. The legislation administered by the Ministry of Social Development allows us to check the information that you give us. This may happen when you apply for assistance and at any time after that. The Privacy Act 1993 requires us to tell you why we collect the information and what we will do with it.

Why we collect informationThe information you give us is collected under the authority of the legislation administered by the Ministry of Social Development and will be held by the Ministry of Social Development.

The information is collected for the purposes of the legislation administered by the Ministry of Social Development including:

• granting benefits and other assistance under the Social Security Act 2018

• delivering superannuation services under the New Zealand Superannuation and Retirement Income Act 2001

• delivering assistance under the Veterans’ Support Act 2014

• providing services under the Residential Care and Disability Support Services Act 2018

• statistical and research purposes

• providing advice to Government

• providing support and services for you and your family

• providing education related services

• care and protection needs of children

• assessing eligibility for social housing and calculating income-related rents under the Housing Restructuring and Tenancy Matters Act 1992

• assessing whether you and/or your partner may be entitled to an overseas pension, benefit or allowance.

You are not required to give the Ministry of Social Development information, but if you do not give us all the information we ask for, your application for benefits or pensions and other assistance may be declined.

We may contact health practitionersThe Ministry of Social Development may contact health practitioners to check any health related information you give us.

We may use information for public housingInformation you give us when you apply for assistance, and at any time after that, may also be used for public housing purposes under the Housing Restructuring and Tenancy Matters Act 1992, including reviewing your eligibility for social housing or your income-related rent.Public housing is subsidised housing available to people in the greatest need of housing for the duration of their need. It is provided by Housing New Zealand and approved community housing providers.

We may compare the information you give us with information held by other agenciesThe information you give us may be compared with information held by other agencies such as Inland Revenue, the Ministry of Justice, Department of Corrections, New Zealand Customs Service, Department of Internal Affairs, Accident Compensation Corporation, Housing New Zealand Corporation, Ministry of Health and Immigration New Zealand. It may also be compared with social security information (for example, pension or benefit information) held by other governments (including Australia , Malta and the Netherlands).

We may share information with Inland RevenueUnder the Tax Administration Act 1994, if you have dependent children, the information you give us may be shared with Inland Revenue for the purpose of administering Working for Families Tax Credits. Inland Revenue may also:

• use the information for the purposes of child support, student loans and taxation

• disclose it to the Ministry of Business, Innovation, and Employment, Statistics New Zealand, the Ministry of Justice, the Accident Compensation Corporation, and the Ministry of Education

• disclose your personal information to your partner.

We may give information to service providers, employers, public housing providers and childcare providersThe Ministry of Social Development may:

• give employers information about you if you use our employment services

• share information with childcare centres to administer your entitlement to childcare assistance

• give information about you to the Tertiary Education Commission, Workbridge, training providers, career services or other agencies that have a formal agreement to provide services on behalf of the Ministry of Social Development, if you use our employment services

• share information about you with public housing providers (such as Housing New Zealand) to administer your housing-related assistance.

We may use your information to give you a better serviceOther information that you give us that is not required to assess your entitlement may be used to provide a better service to you.

You have the right to see and correct your information Under the Privacy Act 1993 you have the right to ask to see all information we hold about you and to ask us to correct that information.


Student’s declaration The information I have provided is true and I have not left anything out. I have read and understood the Privacy Statement and my obligations for Student Allowance. I understand that if I have made a false statement or don’t tell StudyLink of a change in my circumstances or fail to meet my obligations that my Student Allowance payments may stop. If this happens I understand that I will have to pay back any overpayments and I could be prosecuted.

Student’s signature

Day Month Year

Documents to provideOnly for people who are applying for the first timeAll documents sent to StudyLink must be a verified copy. A verified copy is a copy of the original document which has been signed and dated by someone like a Solicitor/Lawyer, Notary Public, Court Registrar, an approved person at an education provider, school principal, StudyLink or Work and Income staff member or Justice of the Peace (listed in the Yellow Pages) who can confirm that the copy is the same as the original. They must print their name and title on each page and write that it is a true copy and sign it. You need to provide any information we need before the end of your course or your Student Allowance application may be declined.

The best way to send your documents to us is online using www.connect.co.nz. Please remember to include your name and client number with any documents you send to us. For more information visit www.connect.co.nz

If you have been involved in a family breakdown or have other exceptional circumstances we need either:A supporting statement from your doctor, counsellor or someone else of standing in the community such as your School Principal, Minister or Kaumātua. This can be a letter or the supporting statement included with this application (pages 7–8), or

If you haven’t already spoken to a professional who can provide this information we will:

• need to confirm your situation with your parent(s) or someone else who can do this. This can be a letter or the supporting statement included with this application (pages 7–8). We will also need to talk to them, or

• ask you to meet with a StudyLink staff member to discuss your application.

If you are (or have been) living with an appointed legal guardian, the legal document that proves this.

If you are an orphan your parents’ death certificates.


Student Allowance Independent Circumstances Allowancesupporting statement – student details

Use this form to support your application for an Independent Circumstances Allowance under the family breakdown criteria. If you’ve already spoken to a professional, like a doctor or counsellor, you can ask them to complete this form. Or you can ask someone of standing in the community (an independent, trustworthy person), who is familiar with and can confirm your situation. This could be someone like your School Principal, Lawyer, Police Officer or Kaumatua. If you don’t know someone of standing in the community, this could be completed by someone else who is familiar with your situation, for example a sibling or family friend. If you already have evidence that supports your application you can send this to us instead.

Please print clearly using black or blue pen only. Once you’ve had the form completed send your form and any other documents to us online using www.connect.co.nz. Please remember to include your name and client number with any documents you send. For more information visit www.connect.co.nzThis section is to be completed by the student.Student’s client number

This is a number issued to you by StudyLink or Work and Income. If you don’t have one or don’t know it, leave this question blank.

Client number

Student’s legal name

This is your legal name as it appears on your Passport or Birth Certificate.


Student’s date of birth

Day Month Year

Student’s declaration I have read and understood the Privacy Act information on page 5.

Student’s signature

Day Month Year


Student Allowance Independent Circumstances Allowancesupporting statement

This section could be completed by the student’s doctor, counsellor or someone else of standing in the community who is familiar with their situation. If you don’t know someone of standing within the community this could be completed by someone else who is familiar with their situation, for example a sibling or family friend.

1. What is your legal name as it appears on your birth certificate?


2. What is your relationship to the student (such as a doctor or counsellor)?

3. What is your postal address? Please note, this must be a New Zealand address.



NEW ZEALAND

4. How can we contact you? We may contact you about this supporting statement.


5. Please name the parent(s) that the breakdown has occurred with.

6. In your opinion, would it be unreasonable for the student to live with and receive financial assistance from any parent? Please explain in detail:

Yes No

7. Have the student’s parent(s) or any other person been providing any ongoing financial support?

Yes (please explain below who has been providing support, and what this includes) No

8. Please provide any other information that you feel would assist us in making a decision for this student.You can continue on a separate piece of paper if required.

Signature

Day Month Year

Please provide your professional stamp or alternatively attach your business card


Seven steps to student financesExams finish

STEP 1 – Apply at www.studylink.govt.nz for financial assistance

STEP 2 – We will start processing the applicationWe’ll check the information that’s given to us and get things underway. Nothing needs to be done at this point unless we make contact.

STEP 3 – We will make contactWe’ll send a letter advising what we need next. The letter needs to be signed and returned (if required) and any documents we’ve asked for need to be sent to us.

STEP 4 – Use MyStudyLink to track the application:• check to see if documents have been received• check the Student Allowance and Student Loan status• view and accept the Student Loan Contract• view and update personal details• apply for course-related costs• view mail.Please note: MyStudyLink only displays payments and information relating to Student Loan, Student Allowance and scholarships.

STEP 5 – We check study details with the education providerEnrolment needs to be fully completed before this can happen.

STEP 6 – We will finish processing the applicationWe’ll send a letter advising what we have assessed entitlement for and when the payments will start.

Course starts

STEP 7 – Payments can startThe earliest that payments can start is in the second week of the course. This is because we make payments in arrears.

If an application for Student Allowance has been made, we’ll send a letter advising what happens next. Enough time needs to be allowed for all seven steps to be completed, so the application needs to be made as soon as possible. If the application is not made on time or we don’t receive all the information we need, we can’t make payments on time.

Save time – Get it done online www.studylink.govt.nz

http://www.studylink.govt.nz

SLICAW – JAN 2020

MyStudyLinkget it all done online

• check out what financial assistance you may be able to get

• apply for your student finances

• check your Student Allowance and Student Loan application status

• view and update your personal details

• change the amount of your living cost payments and apply for your course-related costs

• view details of your next payment and previous transactions

• view your mail

• view and accept your Student Loan Contract.

How to contact us

Website: www.studylink.govt.nz

Phone: 0800 88 99 00

Using ConnectA quick and easy way to send us your documents

1. Create an account at www.connect.co.nz with your RealMe login

2. Upload your verified documents

3. Submit to StudyLink